胃前庭部の大きな線状潰瘍とビランを伴ったlymphoid hyperplasiaの1例

A LARGE LINEAR ULCER IN THE ANTRUM CONCOMITANT WITH LYMPHOID HYPERPLASIA ACCOMPANIED WITH EROSIONS, A CASE REPORT

　本症は他にもreactive lymphoreticular hyperplasia等の多くの名称があり，最近散発的に症例報告がなされており，胃癌，特に早期癌との鑑別に非常な興味を持たれている疾患である．私共も3例の本症に遭遇し，いずれも早期癌と極めて類似した病像を呈したが，そのうちの1例を報告する．

　A recently encountered case of lymphoid hyperplasia of the stomach, often having much in common in its findings with those of early gastric cancer, is described in this paper.

　A male mechanic, 38 years of age, had episodes of hematemesis twice in the past, 4 and 12 years ago respectively. This time he visited the authors' hospital on account of melena. Endoscopy examination revealed a long and broad linear ulcer in the antrum, running perpendicular to the long axis of the stomach, extending all the way from the anterior wall across the greater curvature over to the posterior wall. Mucosal convergence toward the lesion was conspicious and malignant changes were apparent in the discontinued tips of the rugae. Cancer cells were negative by biopsy under direct view. Peristaltic waves were so strong in the antrum that it was hard to get a good double contrast radiograph. Proportioned compression brought out a broad linear ulcer, which showed very diversified shapes according to the degrees of compression applied. Mucosal convergence as well as abrupt cessation of the rugae suggested malignant changes.

　Gross observation of the resected specimen showed a broad and long linear ulcer in the antrum, perpendicular to the long axis of the stomach. Discontinued mucosal folds in the surrounding areas and the extent of erosions were also suggestive of cancerous nature of the lesion. Histopathologically proliferation of lymphoid tissues in the submucosal layer was seen to correspond in its extent and its localization with the linear ulcer mentioned above. Erosions were seen here and there in this proliferated part, but there was only one ulcer lesion (Ul-Ⅱ) in the whole area.